<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="{$row.user_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Customer_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-customer_id" data-rule="required" data-source="member/member/index" class="form-control selectpage" name="row[customer_id]" type="text" value="{$row.customer_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Legal_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-legal_name" class="form-control" name="row[legal_name]" type="text" value="{$row.legal_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Birthday')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-birthday" class="form-control datetimepicker" data-date-format="YYYY-MM-DD" data-use-current="true" name="row[birthday]" type="text" value="{$row.birthday}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" class="form-control" name="row[phone]" type="text" value="{$row.phone|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zxdate')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zxdate" class="form-control datetimepicker" data-date-format="YYYY-MM-DD" data-use-current="true" name="row[zxdate]" type="text" value="{$row.zxdate}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Xyk_total_money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-xyk_total_money" class="form-control" step="0.01" name="row[xyk_total_money]" type="number" value="{$row.xyk_total_money|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Loan_count')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-loan_count" class="form-control" name="row[loan_count]" type="number" value="{$row.loan_count|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Loan_type')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-loan_type" class="form-control" name="row[loan_type]" type="text" value="{$row.loan_type|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Loan_money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-loan_money" class="form-control" step="0.01" name="row[loan_money]" type="number" value="{$row.loan_money|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Dg_dxyk_count')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-dg_dxyk_count" class="form-control" name="row[dg_dxyk_count]" type="number" value="{$row.dg_dxyk_count|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Dg_dxyk_total_money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-dg_dxyk_total_money" class="form-control" step="0.01" name="row[dg_dxyk_total_money]" type="number" value="{$row.dg_dxyk_total_money|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Dg_dxyk_balance')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-dg_dxyk_balance" class="form-control" step="0.01" name="row[dg_dxyk_balance]" type="number" value="{$row.dg_dxyk_balance|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Two_year_nums')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-two_year_nums" class="form-control" name="row[two_year_nums]" type="number" value="{$row.two_year_nums|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Five_year_nums')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-five_year_nums" class="form-control" name="row[five_year_nums]" type="number" value="{$row.five_year_nums|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Three_mounth_nums')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Three_mounth_nums" class="form-control" name="row[Three_mounth_nums]" type="number" value="{$row.Three_mounth_nums|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Three_mounth_qualification_check')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Three_mounth_qualification_check" class="form-control" name="row[Three_mounth_qualification_check]" type="text" value="{$row.Three_mounth_qualification_check|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Three_mounth_legal_qualification_check')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Three_mounth_legal_qualification_check" class="form-control" name="row[Three_mounth_legal_qualification_check]" type="text" value="{$row.Three_mounth_legal_qualification_check|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Three_mounth_credit_approval')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Three_mounth_credit_approval" class="form-control" name="row[Three_mounth_credit_approval]" type="text" value="{$row.Three_mounth_credit_approval|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Three_mounth_guarantee_qualification_check')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Three_mounth_guarantee_qualification_check" class="form-control" name="row[Three_mounth_guarantee_qualification_check]" type="text" value="{$row.Three_mounth_guarantee_qualification_check|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Six_mounth_qualification_check')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Six_mounth_qualification_check" class="form-control" name="row[Six_mounth_qualification_check]" type="text" value="{$row.Six_mounth_qualification_check|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Six_mounth_legal_qualification_check')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Six_mounth_legal_qualification_check" class="form-control" name="row[Six_mounth_legal_qualification_check]" type="text" value="{$row.Six_mounth_legal_qualification_check|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Six_mounth_credit_approval')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Six_mounth_credit_approval" class="form-control" name="row[Six_mounth_credit_approval]" type="text" value="{$row.Six_mounth_credit_approval|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Six_mounth_guarantee_qualification_check')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-Six_mounth_guarantee_qualification_check" class="form-control" name="row[Six_mounth_guarantee_qualification_check]" type="text" value="{$row.Six_mounth_guarantee_qualification_check|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
